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The topic of harm reduction can be a controversial subject. Many people feel that giving methadone to a heroin addict just promotes addiction or that providing clean needles is just encouraging drug use. According to Jarlias (2017) harm reduction became a process when more information was obtained about the spread of HIV. Since them, harm reduction has been used but it has been difficult to up scale many of these programs because many people think that it condones drug use.
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If you look at the chart above, it is easy to see that harm reduction measures are put into place for things that could be extremely harmful to us. For example, if we all drove around at 100mph, there would be even more accident related deaths than there are today. The same is true of harm reduction with drugs. There are a lot of misconceptions surrounding harm reduction. While it can appear to be condoning drug use, it actually creates a safer enviornment where a person can begin to decrease their intake while in a controlled setting. Many methadone clinics offer therapy, case management, and health checks as part of the program. Csak et al (2021) states that many people who have used drugs for a long period of time have underlying health issues and not a lot of access to health care. Going to a methadone clinic or another clinic that practices harm reduction can help monitor those health issues. Also, people who attend these clinics are at less of a risk to experience significant withdrawal symtoms and even overdose. Another benefit is that people are able to gain education and information about drug use and even how to get help that they might not otherwise know. This is far better than keeping silent about it and not seeking help.
Photo from International Harm Reduction.
Another thing to consider is that while harm reduction clinics can be expensive to run, they actually save money in the long run. One study, that looked at heroin use and HIV, showed that harm reduction clinics reduced the risk of HIV buy 54% (Wilson et al, 2015.) If you think about the cost of medical expenses that goes into treating a person with HIV, it’s easy to see that the harm reduction approach saves money. Many people who actively use drugs don’t have health insurance. Drug use has led to a loss of employment. Continuing to implement harm reduction can continue to save lives while reducing the cost needed to manage the health issues that stem for drug use.
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The above picture shows what could happen if we expanded harm reduction programs.
References:
Wilson D.P., Donald B., Shattock A.J., Wilson D., Fraser-Hurt N.(2015) The Cost Effectiveness of Harm Reduction 26(1) (pg. S5 – S11) https://doi.org/10.1016/j.drugpo.2014.11.007
Csák, R., Shirley-Beavan, S., McHenry, A.E. et al. (2021)Harm reduction must be recognised an essential public health intervention during crises. Harm Reduct J 18, 128. https://doi.org/10.1186/s12954-021-00573-6
Des Jarlais, D.C. (2017) Harm reduction in the USA: the research perspective and an archive to David Purchase. Harm Reduct J 14, 51. https://doi.org/10.1186/s12954-017-0178-6
Reply ton
Substance and alcohol abuse does not just affect those that are young. The most commonly abused substance by the elderly is alcohol (Li & Caltabiano, 2017). It has been noted that the present generation of older adults have had an increase of consumed alcohol versus previous generations (Medene, 2019). Alcohol abuse has been trending upward especially among women. In fact, between 2001 and 2013, there was a 107% increase among individuals that were 65 or older that had an alcohol use disorder (Sugarman & Greenfield, 2021).
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As an individual normally ages, the decline of cognitive processes or functions occur due to diverse parts of the brain shrinking. The most vulnerable areas of aging within the brain for alteration is the prefrontal cortex and the hippocampus. The more the individual ages the more pronounced the effects will become on the brain. This includes impact on memory, processing information and learning. Alcohol consumption is an increased risk factor for the elder to be more prone to dementia. There is a likelihood that other medical or mental disorders are associated to the use of alcohol in older adults (Omega, 2020).
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Pharmacological prescription drugs are a big problem with older adults. The eldery are also apt to abuse prescriptions and are the highest rated age group to abuse prescription drugs (Li & Caltabiano, 2017). Common psychotropic drugs that the elderly use are opioid and benzodiazepines which can be potentially addictive. There are safety issues that play along with older adults and the polypharmacy. The combination of both alcohol and potentially addictive drugs can cause negative reactions in the older adult as well as being dangerous. Older adults have larger consequences with how it alters the body. When a person ages, the metabolism, distribution and absorption of the body changes (Tevik, Selbaek, Engedal, etc; 2017). Those that are malnourished and drink heavily will experience decreased blood flow in the liver and metabolize the alcohol and drug slower. These effects can even be produced at low to moderate levels of alcohol use. Each person may vary to the adverse effects but they are increased. The alcohol exemplifies the effects of the drug that is taken. This includes decreased motor skills, drowsiness or sedations. This puts the individual at risk for deepening depression, risks of accidents, liver problems, heart complications, or possible death.
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Alcohol and substance abuse with the elderly does not just impact the individual. In fact, it causes problems socially and in the community. It produces challenges within the courts, possibilities of domestic violence occuring, and the health system. Hospitals, nursing homes and other institutional settings are noticing a rise with alcohol abuse with older people (Li & Caltabiano, 2017).
Mental and physical health should be provided to increase health accommodation and an individual’s quality of life. Unfortunately, there are not many facilitations to acclimate the elderly with these problems (Munoz, Ausin, Santo-Olmo, etch, 2018). Not only that, but recognition of an older adult having problems with alcohol or substance is under-recognized. It is important for doctors to have protocol in screening and assessments of individuals that are having cognitive decline and not assume that it is just the aging process or medications causing recognizable signs of alcohol or substance abuse.
References
Aging, G. H. (2021, July 25). An invisible epidemic: Substance abuse among baby boomers in Europe. GLOBAL HEALTH AGING. Retrieved December 14, 2021, from https://globalhealthaging.org/2015/01/08/an-invisible-epidemic-substance-abuse-among-baby-boomers-in-europe/
Li, W., & Caltabiano, N. (2017). Prevalence of substance abuse and socio-economic differences in substance abuse in an australian community-dwelling elderly sample. Health Psychology Open, 4(1), 2055102917708136-2055102917708136. https://doi.org/10.1177/2055102917708136
Mende, M. A. (2019, July 5). Alcohol in the aging brain – the interplay between alcohol consumption, cognitive decline and the cardiovascular system. Frontiers in neuroscience. Retrieved December 14, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624477/
Muñoz, M., Ausín, B., Santos-Olmo, A., Härter, M., Volkert, J., Schulz, H., Sehner, S., Dehoust, M. C., Suling, A., Wegscheider, K., Canuto, A., Crawford, M. J., Grassi, L., Ronch, C. D., Hershkovitz, Y., Quirk, A., Rotenstein, O., Shalev, A. Y., Strehle, J., . . . Andreas, S. (2018). Alcohol use, abuse and dependence in an older European population: Results from the MentDis_ICF65+ study. PLoS One, 13(4)http://dx.doi.org/10.1371/journal.pone.0196574
Substance abuse among the elderly. RSS. (n.d.). Retrieved December 14, 2021, from https://www.stoufferlegal.com/blog/substance-abuse-among-the-elderly
Substance use and older adults. Prevention Lane. (2020, January 10). Retrieved December 14, 2021, from https://preventionlane.org/substance-use-older-adults
Sugarman, D., & Greenfield, S. (2021, September 24). Rising alcohol use among older adults. Harvard Health. Retrieved December 14, 2021, from https://www.health.harvard.edu/blog/rising-alcohol-use-among-older-adult-202109242599
Tevik, K., Selbæk, G., Engedal, K., Seim, A., Krokstad, S., & Anne-S Helvik. (2017). Use of alcohol and drugs with addiction potential among older women and men in a population-based study. The Nord-Trøndelag Health Study 2006-2008 (HUNT3). PLoS One, 12(9)http://dx.doi.org/10.1371/journal.pone.0184428
Reminiscence in the face of death of a filipino elderly with substance use disorder: The case of burt. (2020). Omega: Journal of Death and Dying, , 30222820976276-30222820976276. https://doi.org/10.1177/0030222820976276